FOR OFFICE USE:
NAME: _________________________________________________
LAST, FIRST, MIDDLE INITIAL
Screening Interview: -----/----/----- Second Interview: -----/----/-----
Employment Application
An Equal Opportunity Employer. At-Will Employer.
Please Print
__________
Date of Application
Position(s) applying for: ___________________________________________ FT PT
Date available to start: _____________________ Will you travel if job requires it? Yes No
Referral Source: Advertisement Employee Relative Walk-in
Government Employment Agency Private Employment Agency
Other: _______________________________________________________
1. Do you have any friends or relatives working for San Luis Obispo Symphony?
If yes, state name(s) and relationship: ............................................................ Yes No
_____________________________ _______________ _______________________
Name Relationship Position Held
Personal Information
________________________________ ___________________ _____________
Last Name First Name Middle
Present Address
______________________________ _______________ ___ _____-____
No. & Street City State Zip
Permanent Address (if different from present address)
______________________________ _______________ ___ _____-____
No. & Street City State Zip
(___) ___-____ (___) ___-____ (___) ___-____
Business Phone Home Phone Cell phone
What is the best time to contact you? Morning Afternoon Evening
May we contact you at work? Yes No (___) ___-____ Best time to contact at work: _______
Business Phone
2. Have you ever applied to or worked for SLO Symphony before? .................. Yes No
If yes, when? ___________________________________
3. Why are you applying for work at SLO Symphony?
____________________________________________________________
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SLO Symphony Employment App 12/07
4. If hired, would you have a reliable means of transportation to and from work? Yes No
5. Are you at least 18 years old? .......................................................................... Yes No
6. If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live
and work in this country? ............................................................................ Yes No
7. Are you able to perform the essential functions of the job for which you are applying, either
with or without reasonable accommodation? ............................................. Yes No
If no, describe the functions that cannot be performed.
____________________________________________________________
____________________________________________________________
____________________________________________________________
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential
functions. Hire may be subject to passing a medical examination, and to skill and agility tests.)
8. Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for
marijuana-related offenses that are more than two years old need not be listed.) ...... Yes No
If yes, state nature of the crime(s), when and where convicted, and disposition of the case.
____________________________________________________________
____________________________________________________________
____________________________________________________________
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the
surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however, be considered.)
9. Have you ever been terminated or asked to resign from a job? Yes No
If yes, explain: _______________________________________________________________________
___________________________________________________________________________________
Education, Training and Experience
A: List the last three schools attended, starting with the most recent one. B: List city & state of school. C: List number of years
completed. D: Indicate any degree or diploma earned. E: Pertinent coursework. F: GPA
A: School Name B: City & State C: Years D: Degree E: Pertinent coursework F:
completed or diploma GPA
List any foreign languages and check the box (es) that best describes your skill level.
Language Fluent: read, write, & speak Read Write Speak
List any musical instruments you play and check the box (es) that best describes your skill level.
Instrument Describe training background Accomplished Can teach Other
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SLO Symphony Employment App 12/07
Employment History
List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all
periods of unemployment, Military service, and volunteer activities. You must complete this section even if attaching a resume.
Use reverse side of this paper if necessary to cover the 5 year period.
______________________________ (___) ___-____
Name of Employer Telephone No.
______________________________ ______________________________
Type of Business Your Supervisor's Name
______________________________ _______________ ___ _____-____
Address & Street City State Zip
Dates of Employment:__________ __________ Hourly/Salary Pay:__________ __________
From To Starting Ending
____________________________________________________________
Your Position and Duties
____________________________________________________________
Reason for Leaving
May we contact this employer for a reference? Yes No
If “No”, Explain:
______________________________ (___) ___-____
Name of Employer Telephone No.
______________________________ ______________________________
Type of Business Your Supervisor's Name
______________________________ _______________ ___ _____-____
Address & Street City State Zip
Dates of Employment:__________ __________ Hourly/Salary Pay:__________ __________
From To Starting Ending
____________________________________________________________
Your Position and Duties
____________________________________________________________
Reason for Leaving
May we contact this employer for a reference? Yes No
If “No”, Explain:
______________________________ (___) ___-____
Name of Employer Telephone No.
______________________________ ______________________________
Type of Business Your Supervisor's Name
______________________________ _______________ ___ _____-____
Address & Street City State Zip
Dates of Employment:__________ __________ Hourly/Salary Pay:__________ __________
From To Starting Ending
____________________________________________________________
Your Position and Duties
____________________________________________________________
Reason for Leaving
May we contact this employer for a reference? Yes No
If “No”, Explain:
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SLO Symphony Employment App 12/07
Civic Activities
List any professional, trade, business or civic activities, and offices held. Exclude groups which indicate race, color, religion, sex,
national origin, or any other protected class.
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
References
List below three persons not related to you who have knowledge of your work performance within the last
three years.
___________________ ___________________ (___) ___-____
First Name Last Name Telephone No.
______________________________ _______________ ___ _____-____
Address & Street City State Zip
_____________________________ ___
Occupation No. of Years Acquainted
________________________________________
How are you acquainted? (Co-worker? Supervisor?, etc.)
___________________ ___________________ (___) ___-____
First Name Last Name Telephone No.
______________________________ _______________ ___ _____-____
Address & Street City State Zip
_____________________________ __
Occupation No. of Years Acquainted
________________________________________
How are you acquainted? (Co-worker? Supervisor?, etc.)
___________________ ___________________ (___) ___-____
First Name Last Name Telephone No.
______________________________ _______________ ___ _____-____
Address & Street City State Zip
_____________________________ __
Occupation No. of Years Acquainted
________________________________________
How are you acquainted? (Co-worker? Supervisor?, etc.)
Please answer the following questions:
a. Can you type? Yes No Speed ________
b. Are you familiar with classical music? Yes No
c. What software are you familiar with? _____________________________________________________
d. Can you compose letters? Yes No
e. Have you done any public speaking? Yes No
f. Are you familiar with CA arts education content standards? Yes No
g. If hired for a position that requires driving for the Symphony, can you provide a valid drivers license,
proof of insurance and a current DMV record? Yes No
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SLO Symphony Employment App 12/07
h. Summarize any special skills and qualifications applicable to the position for which you are applying:
_______________________________________________________________________________________
_______________________________________________________________________________________
Availability
There are certain times of the year that are especially critical to the Symphony. As a result, we do not
schedule vacations during these times, which change periodically. (Employees are given ample advance
notice). Are there any times of the year that you are unavailable to work?
______________________________________________________________________________________
Please furnish any other information you feel may be beneficial to your application:
_______________________________________________________________________________________
_______________________________________________________________________________________
Please Read Carefully, Initial Each Paragraph and Sign Below
______ I hereby certify that I have not knowingly withheld any information that might adversely affect my
Initials chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further
certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or
misstatement of material fact on this application or on any document used to secure employment shall be grounds for
rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before
discovery.
______ I hereby authorize the SLO Symphony to thoroughly investigate my references, work record, education
Initials and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose
to the Symphony any and all letters, reports and other information related to my work records, without giving me prior
notice of such disclosure. In addition, I hereby release the SLO Symphony, my former employers and all other persons,
corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way
related to such investigation or disclosure.
____
Initials I understand that nothing contained in the application or conveyed during any interview which may be granted or
during my employment, if hired, is intended to create an employment contract between me and the SLO Symphony. In
addition, I understand and agree that if I am employed my employment is for no definite or determinable period and
may be terminated at any time, with or without prior notice, at the option of either myself or the SLO Symphony and
that no promises or representations contrary to the foregoing are binding on the SLO Symphony unless made in writing
and signed by me and the SLO Symphony’s designated representative.
______
Initials Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action,
tax lien or outstanding judgment) be conducted by internal personnel employed by the SLO Symphony, I am entitled to
copies of any such public records obtained by the SLO Symphony unless I mark the check box below. If I am not hired as
a result of such information, I am entitled to a copy of any such records even though I have checked the box below.
I waive receipt of a copy of any public record described in the paragraph above
_______ ____________________________________________________________________
Date Applicant’s Signature
Note: This application will remain “open” for consideration for three months, after which, a new one must
be submitted. Thank you.
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SLO Symphony Employment App 12/07